Proceedings of the 13th Meeting of the
COMCEC Poverty Alleviation Working Group
10
country are; inequalities in health are observed between different socioeconomic and geographic
groups -coastal areas, private sector is growing rapidly contributing to out-of-pocket expenses and
fragmented and poorly designed health information systems due to underinvestment.
The main learnings of the case studies can be summarized as; Understanding each context in order
to form/reform policies is vital; Turkey and Tunisia is a good example, Importance of political
leadership; Indonesia internal concerns were the main drivers of change and progress, Gaps still
exist in rural and remote areas –challenge to improve health infrastructure and to attract more
high-skilled health workers; Indonesia and Turkey are good examples of achieving this with the
right incentives and short-term contracts, Common challenge of tackling emerging NCDs, health
insurance is crucial to achieve UHC and secure interest of the poor people, involving private sector
rationally and Importance of and current lack of health information systems. Dr. Ahmed concluded
the second part of his presentation by making four overarching recommendations; a. Demand and
supply side changes need to happen simultaneously, b. Focus on Universal Health Coverage to
provide essential services to the most under-served parts of the population, c. Strengthen
community-based primary health care in order to reach poor population and d. Create Incentives
for skilled health personnel to provide services in rural and remote areas.
Questions and Comments:
Comment: It was stated that Turkish government now focuses on the improving quality health
services and primary healthcare, combatting non-communicable diseases as well as enhancing the
infrastructure by city hospitals which have great health campuses with high technology and high
bed capacity.
Comment: Insurance fund covers only people who work in formal sector in Tunisia. Poor people
benefit from free health care in the public facilities. The government has initiated a special program
to resolve challenges in health to increase coverage of poor families.
Comment: National Health Insurance (JKN) started in January 2014 in Indonesia. Currently, 280
million people are covered by the JKN and the government directly covers 60 percent of them. The
growing problem in Indonesia is about middle-income group because informal workers are in this
group heavily.
Question: Increasing life expectancy also leads to aging population problem and this puts a burden
on the social security and health system of the countries.
Question: It was asked whether NGOs can help governments to improve and augment the access
to health services.
Answer: Dr. Ahmed answered, in terms of aging population, by stating that aging problem is not
just about health but also a problem of social assistance. It necessitates more financial and human
resources. Regarding the NGOs, he responded that they contribute significantly in some countries.
If the question of accountability and quality is solved, NGOs should always be on the forefront
among other private sector actors.